Resignation email by Barts and the London orthopaedic consultant sparks inquiry

The London Hospital in Whitechapel where David Goodier has resigned in protest at standards of care.
A move into a new building begins this month. Photograph: Karen Robinson for the Guardian
Karen Robinson/Guardian

An inquiry has been launched into a leading London hospital trust after a consultant claimed in a devastating resignation email that poor management and government cuts had resulted in infections, pain and starvation for dozens of patients.

David Goodier, a consultant orthopaedic surgeon at Barts and the London NHS Trust, wrote that patients with broken bones were being physically harmed as managers strove to hit waiting list targets and cut budgets.

Prof Norman Williams, the president of the Royal College of Surgeons who works part time at the hospital, has also written to the hospital's medical council expressing his own concerns at an apparent "appalling deterioration" of surgical services. He warned that a failure to investigate could result in allegations of a cover-up similar to "Mid Staffs" – a reference to Mid Staffordshire hospital, where hundreds of patients died because of substandard care.

Now, the Royal College has been asked by the hospital to conduct an independent inquiry into Goodier's claims and similar complaints from other members of staff.

The inquiry, uncovered by the Guardian and BBC London, will result in calls for the Department of Health and the Care Quality Commission to intervene. Goodier, 49, trained at the Royal London Hospital in Whitechapel and has worked at the trust for most of his 31 years as a junior doctor, registrar and consultant.

In his email, sent to colleagues in September, he claims that he went "ballistic" at the hospital authorities a year ago because of the lack of commitment to trauma services.

In response, he claimed, a manager "made clear that the only priorities of the trust were 18-week waiting times and the financial state".

"We are regularly out of kit, out of nurses, out of ODPs [operating department practitioners, who plan care] and always out of beds. We have become so used to the situation, it is no longer seen as a crisis, it is the norm."

Those who suffer are not emergency cases, he wrote, but those with less urgent needs who are left while their injuries fester.

"I did an operation last week on a calcaneal [heel bone] fracture that kept getting bumped by more urgent cases. It was three weeks down the line, and had healed in a bad position. There was nothing I could do about him.

"I fixed a compound tibia [leg bone] that was going to get a second look at 48 hours after the initial debridement; she got to theatre six days later," wrote Goodier.

He then described having to tell patients who are not allowed to eat or drink before an operation that their operations have been postponed.

"Most of all, though, I have done ward rounds where I look patients in the eye and tell them they might sit around for three, four, five or even six days of sequential starving, no information, bed rest and sensory deprivation waiting for an operation that might get cancelled at the last minute because 'recovery is full', 'we used all the small fragment sets', '[a named outside contractor] have lost the trays', 'there's no II [image intensifier, a portable X-ray machine] available' etc."

"I have been complicit in a poor standard of trauma care and am guilty of negligence by association. I can no longer stand idly by when patients are at best having their human rights breached, and at worst physically harmed by the care they receive at BLT. It is personally a huge wrench to tear myself away from the hospital I started at as a medical student in 1980 and as a consultant in 1996 … Good luck to you all, and goodbye."

After receiving the email along with many other senior colleagues at the trust, Williams replied: "I know you are one of the most dedicated surgeons in the trust … I too have been troubled by the appalling deterioration of surgical services in this trust for some time. Whoever I talk to complains bitterly about the inability to deliver the high quality of care that they would wish to provide and which their patients have a right to expect … I believe that the medical council has a duty to alert the Care Quality Commission of the situation before further damage is done to our patients."

Williams then wrote an email to Prof Muhammad Magdi Yaqoob, the chairman of the medical council at the trust.

"There are clearly serious problems with the way that surgical treatment is being delivered in this trust especially for emergencies and that does not just mean trauma. The consultant body has a duty to act otherwise they will be deemed to be complicit. I only have to mention Mid Staffs here to alert you to the problem," he wrote.

Insiders at the hospital claim that a number of consultants have voiced their concerns, particularly about non-urgent surgery. Some blamed the lack of resources on the hospital's PFI scheme which they say has drained resources. Others say that managers have no idea how surgeons and consultants actually work.

Williams praised the hospital trust on Thursday and said that he had heard many criticisms from senior staff but also some support for the way it runs many of its departments.

Dale Campbell-Savours, the campaigning Labour peer who has asked parliamentary questions about the resignations of six senior consultants at the trust, welcomed the inquiry. "The loss of consultants at this hospital with an international reputation has been of great concern," he said.

A trust spokeswoman confirmed the Royal College inquiry and said it has invited a medical director from a foundation trust to undertake a review. She said it was decided that it was not "appropriate" to contact the CQC.

She added said that the concerns about availability of surgical instruments had been addressed and significant improvements had been made. "Barts and the London NHS Trust has one of the best clinical safety records in the NHS, and we have the second lowest SHMI [summary hospital-level mortality indicator] rate in England … We have taken this as an opportunity to expand our orthopaedic service," she said.